Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 000219 | CT |
Y | 222Z00000X | Podiatrist | 000219 | CT |
NPI | 1033117866 |
---|---|
Provider Name | Dr. Robert F Weiss |
First Address | Darien, CT 06820-4622 |
Second Address | Darien, CT 06820-4622 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 10/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300091359 | TAX ID (01) | CT |